502700235-11-4-2022-27-AS-LKIG-CL2TJG-20221110134620

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 502700235
Report Date: 11/03/2022
Date Signed: 11/04/2022 09:57:59 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2022 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220822080756

FACILITY NAME:	EL RIO MEMORY CARE COMMUNITY		FACILITY NUMBER:	502700235
ADMINISTRATOR:	KEATON, MARY		FACILITY TYPE:	740
ADDRESS:	2828 HEALTHCARE WAY		TELEPHONE:	(209) 543-3805
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	72	CENSUS: 72	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Mary Keaton		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility did not report incidents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA’S) Kesha Lewis and Albert Johnson conducted an unannounced facility visit on 11/03/2022 to deliver complaint investigation findings. LPA’S met with Administrator Mary Keaton and explained the purpose of today's visit.

The purpose of the visit is to deliver complaint investigation findings from an incident reported to the department received on 08/22/2022.

Based upon documentation reviewed LPA’s observed multiple unwitnessed falls documented on internal documentation 6/30/2022, 7/5/2022, 7/6/2022, 7/19/2022,7/20/2022,7/22/2022. Interviews conducted with administrator and director of resident services they conformed that they do not send incident reports for falls unless resident is sent out to emergency room. R1’s Physician’s report states the resident has a history of falls. Based on records reviews and interviews LPA’S found inconsistencies with facilities incident reports and the department having no record of reports for those dates. Therefore, the second allegation the Facility does not report incidents Is substantiated.

A finding that the complaint is substantiated means the preponderance of evidence standard has been met, therefore the allegation(s) is found to be substantiated.

Exit interview conducted and copy of report provided. Appeal rights given.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/22/2022 and conducted by Evaluator Kesha Lewis

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20220822080756

FACILITY NAME:	EL RIO MEMORY CARE COMMUNITY		FACILITY NUMBER:	502700235
ADMINISTRATOR:	KEATON, MARY		FACILITY TYPE:	740
ADDRESS:	2828 HEALTHCARE WAY		TELEPHONE:	(209) 543-3805
CITY:	MODESTO	STATE: CA	ZIP CODE:	95356
CAPACITY:	72	CENSUS: 72	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Mary Keaton		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
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5
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7
8
9

Facility did not provide supervision to protect resident from sexual assault.

INVESTIGATION FINDINGS:

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This report was amended to include the correct finding.

Allegation: Neglect/Lack of Care and Supervision: Facility staff did not provide supervision to protect
clients from sexual assault against client R1.

Finding: Unsubstantiated

Conclusion: According to staff , they reported two incidents where R1 was sexually touching R2. Three staff members were interviewed who worked on the days of the allegations and they all denied anyone ever reporting the allegations to them. Staff denied witnessing R1 sexually assaulting other clients. R1 denied the allegation. R2 did not talk to the investigator. Other female clients denied any issues with R1.

This complaint is UNSUBSTANTIATED. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Admisstratior and a copy of this report provided.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20220822080756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: EL RIO MEMORY CARE COMMUNITY	FACILITY NUMBER: 502700235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/04/2022 Section Cited CCR 87211(a)(1)(d)	1 2 3 4 5 6 7	each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident.	1 2 3 4 5 6 7	Administrator will review Title 22 Regulations Section 87211 and have an In-service training with all Staff regarding Reporting Requirements. Administrator will submit a written plan ensuring that incidents are reported to the CCL office as required according to the Regulation. Signatures of all
	8 9 10 11 12 13 14	This requirement was not meet as evidenced by interviews and documentation LPA'S reviewed nurse's notes on multiple dates that show falls and there is no records to CCL. This poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	Staff from the training must be submitted to CCL after training is complete. The plan is due by the POC date of 11/04/22.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Kesha Lewis	TELEPHONE: (650) 676-0552
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

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